The growing trend for couples in Singapore is to wait until they are financially secure before they start a family. This often means they delay trying for a baby until their mid-30s.

Learn more about the factors couples should consider when having a baby after 35 and the medical options available to help them conceive.

Ticking biological clock

Did you know that fertility in both men and women declines with age? A woman is born with all the eggs she will ever have and, as she gets older, the number and quality of her eggs decline.

According to Dr Lim, a woman’s fertility starts to decline considerably after 35. Beyond 40, the chances diminish further. When she starts to go through menopause around 50 years of age, her chances of becoming pregnant naturally are almost zero. In summary, a woman’s age is the most important factor when it comes to her chances of conceiving.

Men, on the other hand, continue to produce new sperm throughout their lives. However, both the count and quality decline with age.

Impact of stress

Busy lifestyles, the anticipation and pressure of trying to conceive, and being considerate of the needs of your partner on this journey can all start to add up.

This build-up of stress can affect a couple’s chance of conception.

“I’ve seen cases of couples who have failed to conceive despite IVF treatment, then become pregnant naturally when they stop trying or while on holiday as they let their guard down and take the focus off conceiving,” says Dr Lim. “A more relaxed mental state gives them a higher chance of getting pregnant.”

Facing infertility as a couple

When it comes to pregnancy difficulties, one-third of infertility cases are attributed to the woman, one-third to the man and one-third to the combination of both partners.

As difficulties in conceiving isn’t solely a women’s issue, Dr Lim recommends couples consult an O&G together so that all possible reasons can be investigated and eliminated or treated.

He also notes that approaching infertility as a couple enables them to support and draw strength from each other. Helping (and not judging) your partner during this stressful time is key to a happy and healthy fertility journey.

Going for fertility screening early

Fertility issues are more common than people realise. With 1 in 6 couples facing issues with fertility, Dr Lim advises younger couples to seek medical advice if they have been trying to conceive for a year without success. Couples over 35 years shouldn’t put off seeing a fertility doctor longer than 6 months into trying for a baby.

“Going for fertility screening at an earlier stage will help to identify problems and rectify them early,” says Dr Lim. “These include structural issues like polyps found in the uterine cavity, or endometriosis, which have been known to impair infertility and surgery can improve conception rates.

“If no issues are found during fertility screening, you can then weigh up the decision to start a family later when age alone is the infertility risk factor.”

Simply put, fertility screening is the most responsible and reassuring way to become a parent. It lays the groundwork for couples to either try for a baby with confidence or seek help quickly and early, and bypass the stressful and discouraging experience of trying unsuccessfully for years without knowing the reason.

Medically-aided conception options

IVF isn’t the only option available when trying to conceive, and the treatment your doctor advises very much depends on your medical history and the investigative findings.

For example, intrauterine insemination (IUI), is a simpler and more cost-efficient procedure which involves placing a concentrated amount of sperm inside the woman’s uterus. It is often recommended for younger couples with less fertility issues. However, if the fallopian tubes are blocked, or if the count or motility of the sperm is low, in vitro fertilisation (IVF) is usually recommended.

Your doctor will be in the best position to advise you on the ideal option for your unique circumstances.

What to expect with IVF

In this process, the woman undergoes a series of fertility injections over 10 – 14 days, which help increase the number of eggs developed over that time. At an optimal time, the eggs are retrieved and then fertilised with her husband’s sperm in the lab. The embryos are then grown in a special incubator for 3 – 5 days. Finally, the best embryo(s) are selected and implanted into the woman’s uterus.

In Singapore, you can have 2 embryos transferred at a time or up to 3 in specific circumstances.

“There is a move globally to reduce this to one embryo per transfer due to the increased risks to the mother and babies in a multiple pregnancy,” Dr Lim adds. “Studies have also shown that multiple embryo transfers do not increase the chances of pregnancy compared to cumulative single embryo transfers.”

IVF is not always the golden ticket

With IVF, you still have the same challenges with ageing eggs and sperm as you would normally, so while this treatment may help improve your chances of becoming pregnant in a given cycle, the chances still decrease with age.

Maintaining a healthy lifestyle and diet, and exercising regularly, can also help to increase your odds.

“Overall, couples have a 30 – 35% chance per cycle of becoming pregnant with IVF. This will vary with the woman’s age. Women under the age of 35 have a 40 – 50% chance of becoming pregnant per cycle while those over 45 have only a 1 – 2% likelihood of success per cycle,” shares Dr Lim. “If you are not successful in your first try with IVF, the chance of success in your second cycle will still be the same, that is, 30 – 35% overall.”

That is not to say, however, that for those patients over 40 with a low chance of success per cycle, you should never try again.

Dr Lim shares: “I recall a case where a patient of mine only had one egg collected, and, despite the challenges, she successfully delivered a baby through IVF. It’s heartening to know that for some couples, despite slim odds, hope still exists.”

To learn more about fertility screening and treatment options available, speak to an O&G.

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